Healthcare Provider Details

I. General information

NPI: 1790380160
Provider Name (Legal Business Name): SRIDHAR JANYAVULA DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 W LINCOLN HWY
EXTON PA
19341-2514
US

IV. Provider business mailing address

670 W LINCOLN HWY
EXTON PA
19341-2514
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-4003
  • Fax:
Mailing address:
  • Phone: 713-447-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042049
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: